Healthcare Provider Details

I. General information

NPI: 1730202870
Provider Name (Legal Business Name): NORTH TEXAS FAMILY FOOT CARE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 JOE RAMSEY BLVD BLDG 5
GREENVILLE TX
75401-7727
US

IV. Provider business mailing address

3900 JOE RAMSEY BLVD E BLDG 5
GREENVILLE TX
75401-7727
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-2383
  • Fax: 903-455-9419
Mailing address:
  • Phone: 903-455-2383
  • Fax: 903-455-9419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: KEELI HUNTSMAN
Title or Position: BUSINESS ADMIN
Credential:
Phone: 208-351-5402